Canadian Journal of Cardiology

Shared Risk Factors for Cardiovascular Disease and Cancer: Implications for Preventive Health and Clinical Care in Oncology Patients

Published:April 23, 2016DOI:


      The cardiovascular toxicity of cancer therapy has raised awareness of the importance of heart disease in cancer care among oncologists and cardiologists, leading to the new interdisciplinary field of cardio-oncology. Evidence is accumulating to suggest that risk factors associated with cardiovascular disease are also related to an increased incidence of cancer and excess cancer mortality. We review the epidemiologic evidence that smoking, obesity, poor diet, and inactivity can cause both heart disease and cancer. The importance of cardiovascular disease and cardiovascular risk factors in adversely affecting oncological outcomes and leading to increased cancer mortality is discussed. Cardiotoxicity prediction tools that incorporate cardiac disease and risk factors are described. Raising awareness about shared risk factors for cancer and heart disease may result in more effective advocacy to promote healthy lifestyle changes through the combined efforts of the historically separate specialties of cardiology and oncology.


      En raison de la toxicité cardiovasculaire des traitements anticancéreux, les oncologues et les cardiologues ont pris conscience de l’importance de la cardiopathie dans les soins anticancéreux, ce qui a donné naissance à un nouveau champ interdisciplinaire, la cardio-oncologie. Les données laissant supposer que les facteurs de risque associés à la maladie cardiovasculaire soient aussi liés à une fréquence accrue de cancer et à un taux excessif de mortalité liée au cancer sont de plus en plus nombreuses. Nous avons examiné les données épidémiologiques probantes indiquant que l’usage du tabac, l’obésité, une mauvaise alimentation et la sédentarité peuvent causer la cardiopathie et le cancer. Nous traitons de l’effet délétère d’importance de la maladie cardiovasculaire et des facteurs de risque cardiovasculaires sur l’issue des traitements anticancéreux ainsi que du risque accru connexe de décès par cancer. Une description des outils permettant de prédire la cardiotoxicité, qui tiennent compte de la cardiopathie et des facteurs de risque, est présentée. La prise de conscience relative aux facteurs de risque communs du cancer et de la cardiopathie se traduira peut-être par une sensibilisation plus efficace de l’importance d’adopter un mode de vie sain grâce aux efforts combinés de deux spécialités, la cardiologie et l’oncologie, considérées depuis toujours comme distinctes.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Canadian Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


      1. Xu J, Murphy SL, Kochanek KD, Bastian BA. Deaths: final data for 2013. National Vital Statistics Reports Volume 64, No. 2, Feb 16, 2016. Available at Accessed June 6, 2016.

        • Eyre H.
        • Kahn R.
        • Robertson R.M.
        Preventing cancer, cardiovascular disease, and diabetes. A Common Agenda for the American Cancer Society, the American Diabetes Association, and the American Heart Association.
        Circulation. 2004; 109: 3244-3255
        • Tobe S.W.
        • Stone J.A.
        • Brouwers M.
        • et al.
        Harmonization of guidelines for the prevention and treatment of cardiovascular disease: the C-Change initiative.
        CMAJ. 2011; 183: E1135-E1150
        • Tobe S.W.
        • Stone J.A.
        • Walker K.M.
        • et al.
        Canadian Cardiovascular Harmonized National Guidelines Endeavour (C-CHANGE): 2014 update.
        CMAJ. 2014; 186: 1299-1305
        • Carter B.D.
        • Abnet C.C.
        • Feskanich D.
        • et al.
        Smoking and mortality—beyond established causes.
        N Engl J Med. 2015; 327: 631-640
        • Yusuf S.
        • Hawken S.
        • Ounpuu S.
        • et al.
        • Interheart Study Investigators
        Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the Interheart Study): case-control study.
        Lancet. 2004; 9438: 937-952
      2. Eriksen M, Makay J, Schluger N, et al. Tobacco Atlas. 5th ed. Chapter 8. Available at: Accessed November 30, 2015.

      3. Centers for Disease Control and Prevention (CDC). Consumption of cigarettes and combustible tobacco–United States, 2000-2011. MMWR Morb Mortal Wkly Rep 2012;61:565-9.

        • Islami F.
        • Torre L.A.
        • Jemal A.
        Global trends of lung cancer mortality and smoking prevalence.
        Transl Lung Cancer Res. 2015; 4: 327-338
      4. WHO Global Report on Trends in Prevalence of Tobacco Smoking 2015. World Health Organization, 2015. Available at: Accessed November 30, 2015.

        • Ng M.
        • Fleming T.
        • Robinson M.
        • et al.
        Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013.
        Lancet. 2014; 384: 766-781
        • Bancej C.
        • Jayabalasingham B.
        • Wall R.W.
        • et al.
        Trends and projections of obesity among Canadians.
        Health Promot Chronic Dis Prev Can. 2015; 35: 109-112
        • Calle E.E.
        • Thun M.J.
        • Petrelli J.M.
        • et al.
        Body mass index and mortality in a prospective cohort of U.S. adults.
        N Engl J Med. 1999; 341: 1097-1105
        • McGorrian C.
        • Yusuf S.
        • Islam S.
        • et al.
        Estimating modifiable coronary heart disease risk in multiple regions of the world: the INTERHEART Modifiable Risk Score.
        Eur Heart J. 2011; 32: 581-590
        • Yusuf S.
        • Rangarajan S.
        • Teo K.
        • et al.
        Cardiovascular risk and events in 17 low-, middle-, and high-income countries.
        N Engl J Med. 2014; 371: 818-827
        • Calle E.E.
        • Rodriguez C.
        • Walker-Thurmond K.
        • et al.
        Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults.
        N Engl J Med. 2003; 348: 1625-1638
        • Hu F.B.
        • Willett W.C.
        • Li T.
        • et al.
        Adiposity as compared with physical activity in predicting mortality among women.
        N Engl J Med. 2004; 351: 2694-2703
        • Pan S.Y.
        • Johnson K.C.
        • Ugnat A.-M.
        • et al.
        Association of obesity and cancer risk in Canada.
        Am J Epidemiol. 2004; 159: 259-268
        • Jafri H.
        • Alsheikh-Ali A.A.
        • Karas R.H.
        Baseline and on-treatment high-density lipoprotein cholesterol and the risk of cancer in randomized controlled trials of lipid-altering therapy.
        J Am Coll Cardiol. 2010; 55: 2846-2854
        • Renehan A.G.
        • Tyson M.
        • Egger M.
        • et al.
        Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies.
        Lancet. 2008; 371: 569-578
        • Eliassen A.H.
        • Colditz G.A.
        • Rosner B.
        • et al.
        Adult weight change and risk of postmenopausal breast cancer.
        JAMA. 2006; 296: 193-201
        • Adams T.D.
        • Gress R.E.
        • Smith S.C.
        • et al.
        Long-term mortality after gastric bypass surgery.
        N Engl J Med. 2007; 357: 753-761
        • Sjöström L.
        • Narbro K.
        • Sjöström D.
        • et al.
        Effects of bariatric surgery on mortality in Swedish obese subjects.
        N Engl J Med. 2007; 357: 741-752
        • Tee M.C.
        • Cao Y.
        • Warnock G.L.
        • et al.
        Effect of bariatric surgery on oncologic outcomes: a systematic review and meta-analysis.
        Surg Endosc. 2013; 27: 4449-4456
        • Stocks T.
        • Bjorge T.
        • Ulmer H.
        • et al.
        Metabolic risk score and cancer risk: pooled analysis of seven cohorts.
        Int J Epidemiol. 2015; 44: 353-363
        • Mendonca F.M.
        • de Sousa F.
        • Barbosa A.L.
        • et al.
        Metabolic syndrome and risk of cancer: which link?.
        Metabolism. 2015; 64: 182-189
        • Despres J.-P.
        Body fat distribution and risk of cardiovascular disease. An update.
        Circulation. 2012; 126: 1301-1313
        • Gallagher E.J.
        • LeRoith D.
        Epidemiology and molecular mechanisms tying obesity, diabetes, and the metabolic syndrome with cancer.
        Diabetes Care. 2013; 36: S233-S239
        • Matsuda M.
        • Shimomura I.
        Increased oxidative stress in obesity: implications for metabolic syndrome, diabetes, hypertension, dyslipidemia, atherosclerosis, and cancer.
        Obes Res Clin Pract. 2013; 7: e330-e341
        • Scheid M.P.
        • Sweeney G.
        The role of adiponectin signaling in metabolic syndrome and cancer.
        Rev Endocr Metab Disord. 2014; 15: 157-167
        • VanSaun M.N.
        Molecular pathways: adiponectin and leptin signaling in cancer.
        Clin Cancer Res. 2013; 19: 1926-1932
        • Anand S.S.
        • Hawkes C.
        • de Souza R.J.
        • et al.
        Food consumption and its impact on cardiovascular disease: importance of solutions focused on the globalized food system. A report from the workshop convened by the World Heart Federation.
        J Am Coll Cardiol. 2015; 66: 1590-1614
        • Younus A.
        • Aneni C.E.
        • Spatz E.S.
        • et al.
        Prevalence of ideal cardiovascular health among adults in the United States.
        J Am Coll Cardiol. 2015; 66: 1633-1634
        • Li Y.
        • Hruby A.
        • Bernstein A.M.
        • et al.
        Saturated fats compared with unsaturated fats and sources of carbohydrates in relation to risk of coronary heart disease. A prospective cohort study.
        J Am Coll Cardiol. 2015; 66: 1538-1548
        • Wu H.
        • Flint A.J.
        • Qi Q.
        • et al.
        Association between dietary whole grain intake and risk of mortality. Two large prospective studies in US Men and women.
        JAMA Intern Med. 2015; 175: 373-384
        • Wang X.
        • Ouyang Y.
        • Liu J.
        • et al.
        Fruit and vegetable consumption and mortality from all causes, cardiovascular disease, and cancer: systematic review and dose-response meta-analysis of prospective cohort studies.
        BMJ. 2014; 349: g4490
        • Yang Q.
        • Zhang Z.
        • Gregg E.W.
        • et al.
        Added sugar intake and cardiovascular diseases mortality among US adults.
        JAMA Intern Med. 2014; 174: 516-524
        • Eckel R.H.
        • Jakicic J.M.
        • Ard J.D.
        • et al.
        2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.
        Circulation. 2014; 129: S76-S99
        • Iqbal R.
        • Anand S.
        • Ounpuu S.
        • et al.
        Dietary patterns and the risk of acute myocardial infarction in 52 countries: results of the INTERHEART study.
        Cirulation. 2008; 118: 1929-1937
        • Trichopoulou A.
        • Costacou T.
        • Bamia C.
        • et al.
        Adherence to a Mediterranean diet and survival in a Greek population.
        N Engl J Med. 2003; 348: 2599-2608
        • Dehghan M.
        • Mente A.
        • Teo T.T.
        • et al.
        Relationship between healthy diet and risk of cardiovascular disease among patients on drug therapies for secondary prevention. A prospective cohort study of 31 546 high-risk individuals from 40 countries.
        Circulation. 2012; 126: 2705-2712
        • De Lorgeil M.
        • Renaud S.
        • Salen P.
        • et al.
        Mediterranean Alpha-Linolenic Acid Rich Diet in Secondary Prevention of coronary heart disease.
        Lancet. 1994; 343: 1454-1459
        • De Lorgeril M.
        • Salen P.
        • Martin J.-L.
        • et al.
        Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction. Final report of the Lyon Diet Heart Study.
        Circulation. 1999; 99: 779-785
        • Gomez-Gracia E.
        • Ruiz-Gutierrez V.
        • Fiol M.
        • Lapetra J.
        • et al.
        Primary prevention of cardiovascular disease with a Mediterranean diet.
        N Engl J Med. 2013; 368: 1279-1290
        • Slattery M.L.
        • Boucher K.M.
        • Caan B.J.
        • et al.
        Eating patterns and risk of colon cancer.
        Am J Epidemiol. 1998; 148: 4-16
        • Buckland G.
        • Agudo A.
        • Luján L.
        • et al.
        Adherence to a Mediterranean diet and risk of gastric adenocarcinoma within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort study1-3.
        Am J Clin Nutr. 2010; 91: 381-390
        • DeLorgeril M.
        • Salen P.
        • Martin J.-L.
        • et al.
        Mediterranean dietary pattern in a randomized trial. Pronlonged survival and possible reduced cancer rate.
        Arch Intern Med. 1998; 158: 1181-1187
        • Toledo E.
        • Salas-Salvadó J.
        • Donat-Vargas C.
        • et al.
        Mediterranean diet and invasive breast cancer risk among women at high cardiovascular risk in the PREDIMED trial.
        JAMA Intern Med. 2015; 175: 1752-1760
        • Schwingshackl L.
        • Hoffman G.
        Adherence to Mediterranean diet and risk of cancer: a systematic review and meta-analysis of observational studies.
        Int J Cancer. 2014; : 1884-1897
        • Li T.Y.
        • Rana J.S.
        • Manson J.E.
        • et al.
        Obesity as compared with physical activity in predicting risk of coronary heart disease in women.
        Circulation. 2006; 113: 499-506
        • Held C.
        • Iqbal R.
        • Lear S.A.
        • et al.
        Physical activity levels, ownership of goods promoting sedentary behaviour and risk of myocardial infarction: results of the INTERHEART study.
        Eur Heart J. 2012; 33: 452-466
        • Sattelmair J.
        • Pertman J.
        • Ding E.L.
        • et al.
        Dose response between physical activity and risk of coronary heart disease. A meta-analysis.
        Circulation. 2011; 124: 789-795
        • Pandey A.
        • Garg S.
        • Khunger M.
        • et al.
        Dose-response relationship between physical activity and risk of heart failure. A meta-analysis.
        Circulation. 2015; 132: 1786-1794
        • Kodama S.
        • Saito K.
        • Tanaka S.
        • et al.
        Cardiorespiratory fitness as a quantitative predictor of all-cause mortality and cardiovascular events in healthy men and women. A meta-analysis.
        JAMA. 2009; 301: 2024-2035
        • Meyers J.
        • Prakash M.
        • Froelicher V.
        • et al.
        Exercise capacity and mortality among men referred for exercise testing.
        N Engl J Med. 2002; 346: 793-801
        • Sui X.
        • LaMonte M.J.
        • Laditka J.N.
        • et al.
        Cardiorespiratory fitness and adiposity as mortality predictors in older adults.
        JAMA. 2007; 298: 2507-2516
        • Liu Y.
        • Hu F.
        • Li D.
        • et al.
        Does physical activity reduce the risk of prostate cancer? A systematic review and meta-analysis.
        Eur Urol. 2011; 60: 1029-1043
        • Wu Y.
        • Zhang D.
        • Kang S.
        Physical activity and risk of breast cancer: a meta-analysis of prospective studies.
        Breast Cancer Res Treat. 2013; 137: 869-882
        • Kiemling M.
        • Behrens G.
        • Schmid D.
        • Leitzmann M.F.
        The association between physical activity and bladder cancer: systematic review and meta-analysis.
        Br J Cancer. 2014; 110: 1862-1870
        • Behrens G.
        • Leitzmann M.F.
        The association between physical activity and renal cancer: systematic review and meta-analysis.
        Br J Cancer. 2013; 108: 798-811
        • Behrens G.
        • Jochem C.
        • Keimling M.
        • et al.
        The association between physical activity and gastroesophageal cancer: systematic review and meta-analysis.
        Eur J Epidemiol. 2014; 29: 151-170
        • Keum N.N.
        • Ju W.
        • Lee D.H.
        • et al.
        Leisure-time physical activity and endometrial cancer risk: dose-response meta-analysis of epidemiological studies.
        Int J Cancer. 2014; 135: 682-694
        • Colley R.C.
        • Garriguet D.
        • Janssen I.
        • et al.
        Physical activity of Canadian adults: accelerometer results from the 2007 to 2009 Canadian Health Measures Survey.
        Health Rep. 2011; 22: 7-14
        • Wen C.P.
        • Wai J.P.
        • Tsai M.K.
        • et al.
        Minimum amount of physical activity for reduced mortality and extended life expectancy: a prospective cohort study.
        Lancet. 2011; : 1-10
        • Zhong S.
        • Jiang T.
        • Ma T.
        • et al.
        Association between physical activity and mortality in breast cancer: a meta-analysis of cohort studies.
        Eur J Epidemiol. 2014; 29: 391-404
        • Holmes M.D.
        • Chen W.Y.
        • Feskanich D.
        • et al.
        Physical activity and survival after breast cancer diagnosis.
        JAMA. 2005; 293: 2479-2486
        • Weaver K.E.
        • Foraker R.E.
        • Alfano C.M.
        • et al.
        Cardiovascular risk factors among long-term survivors of breast, prostate, colorectal, and gynecologic cancers: a gap in survivorship care?.
        J Cancer Surviv. 2013; 7: 253-261
        • Meacham L.R.
        • Chow E.J.
        • Ness K.K.
        • et al.
        Cardiovascular risk factors in adult survivors of pediatric cancer—a report from the childhood cancer survivor study.
        Cancer Epidemiol Biomarkers Prev. 2010; 19: 170-181
        • Rademaker J.
        • Schöder H.
        • Ariaratnam N.S.
        • et al.
        Coronary artery disease after radiation therapy for Hodgkin's lymphoma: coronary CT angiography findings and calcium scores in nine asymptomatic patients.
        AJR Am J Roentgenol. 2008; 191: 32-37
        • Buttros D.B.
        • Nahas E.A.
        • Vespoli Hde L.
        • et al.
        Risk of metabolic syndrome in postmenopausal breast cancer survivors.
        Menopause. 2013; 20: 448-454
        • Whitlock M.C.
        • Yeboah J.
        • Burke G.L.
        • et al.
        Cancer and its association with the development of coronary artery calcification: an assessment from the Multi-Ethnic Study of Atherosclerosis.
        J Am Heart Assoc. 2015; 4: e002533
        • Mast M.E.
        • Heijenbrok M.W.
        • Petoukhova A.L.
        • et al.
        Preradiotherapy calcium scores of the coronary arteries in a cohort of women with early-stage breast cancer: a comparison with a cohort of healthy women.
        Int J Radiat Oncol Biol Phys. 2012; 83: 853-858
        • Davis M.K.
        • Rajala J.L.
        • Tyldesley S.
        • Pickles T.
        • Virani S.A.
        The prevalence of cardiac risk factors in men with localized prostate cancer undergoing androgen deprivation therapy in British Columbia, Canada.
        J Oncol. 2015; 2015: 820403-820407
        • Morote J.
        • Gómez-Caamaño A.
        • Alvarez-Ossorio J.L.
        • et al.
        The metabolic syndrome and its components in patients with prostate cancer on androgen deprivation therapy.
        J Urol. 2015; 193: 1963-1969
        • Healy L.A.
        • Howard J.M.
        • Ryan A.M.
        • et al.
        Metabolic syndrome and leptin are associated with adverse pathological features in male colorectal cancer patients.
        Colorectal Dis. 2012; 14: 157-165
        • Piccirillo J.F.
        • Tierney R.M.
        • Costas I.
        • Grove L.
        • Spitznagel E.L.
        Prognostic importance of comorbidity in a hospital-based cancer registry.
        JAMA. 2004; 291: 2441-2447
        • Desch C.E.
        • Penberthy L.
        • Newschaffer C.J.
        • et al.
        Factors that determine the treatment for local and regional prostate cancer.
        Med Care. 1996; 4: 152-162
        • Van Spronsen D.J.
        • Janssen-Heijnen M.L.
        • Breed W.P.
        • Coebergh J.W.
        Prevalence of co-morbidity and its relationship to treatment among unselected patients with Hodgkin‘s disease and non-Hodgkin’s lymphoma, 1993-1996.
        Ann Hematol. 1999; 78: 315-319
        • Dent S.
        • Hopkins S.
        • Graham N.
        • et al.
        The experience of a multidisciplinary clinic in the management of early-stage breast cancer patients receiving trastuzumab therapy: an observational study.
        Cardiol Res Pract. 2012; 2012: 135819
        • Barac A.
        • Murtagh G.
        • Carver J.R.
        • et al.
        Cardiovascular health of patients with cancer and cancer survivors: a roadmap to the next level.
        J Am Coll Cardiol. 2015; 30: 2739-2746
        • Lotrionte M.
        • Biondi-Zoccai G.
        • Abbate A.
        • et al.
        Review and meta-analysis of incidence and clinical predictors of anthracycline cardiotoxicity.
        Am J Cardiol. 2013; 112: 1980-1984
        • Gunaldi M.
        • Duman B.B.
        • Afsar C.U.
        • et al.
        Risk factors for developing cardiotoxicity of trastuzumab in breast cancer patients: an observational single-centre study.
        J Oncol Pharm Pract. 2016; 22: 242-247
        • Hamnvik O.-P.R.
        • Choueiri T.K.
        • Turchin A.
        • et al.
        Clinical risk factors for the development of hypertension in patients treated with inhibitors of the VEGF signaling pathway.
        Cancer. 2015; 121: 311-319
        • Collins C.
        • Weiden P.L.
        Cardiotoxicity of 5-fluorouracil.
        Cancer Treat Rep. 1987; 71: 733-736
        • The Emerging Risk Factors Collaboration
        Association of cardiometabolic multimorbidity with mortality.
        JAMA. 2015; 314: 52-60
        • Kenfield S.A.
        • Stampfer M.J.
        • Chan J.M.
        • Giovannucci E.
        Smoking and prostate cancer survival and recurrence.
        JAMA. 2011; 305: 2548-2555
        • Zu K.
        • Giovannucci E.
        Smoking and aggressive prostate cancer: a review of the epidemiologic evidence.
        Cancer Causes Control. 2009; 20: 1799-1810
        • Gerdtsson A.
        • Poon J.B.
        • Thorek D.L.
        • et al.
        Anthropometric measures at multiple times throughout life and prostate cancer diagnosis, metastasis, and death.
        Eur Urol. 2015; 68: 1076-1082
        • Cao Y.
        • Ma J.
        Body mass index, prostate cancer-specific mortality, and biochemical recurrence: a systematic review and meta-analysis.
        Cancer Prev Res (Phila). 2011; 4: 486-501
        • Azrad M.
        • Demark-Wahnefried W.
        The association between adiposity and breast cancer recurrence and survival: a review of the recent literature.
        Curr Nutr Rep. 2014; 3: 9-15
        • Sharma A.
        • Ng H.
        • Kumar A.
        • et al.
        Colorectal cancer: histopathologic differences in tumor characteristics between patients with and without diabetes.
        Clin Colorectal Cancer. 2014; 13: 54-61
        • Ligibel J.
        Lifestyle factors in cancer survivorship.
        J Clin Oncol. 2012; 30: 3697-3704
        • Dranitsaris G.
        • Rayson D.
        • Vincent M.
        • et al.
        The development of a predictive model to estimate cardiotoxic risk for patients with metastatic breast cancer receiving anthracyclines.
        Breast Cancer Res Treat. 2008; 107: 443-450
      5. Sulpher J, Dattilo F, Law A, et al. Development of a predictive model to estimate cardiotoxic risk associated with anthracyclines and trastuzumab. San Antonio Breast Cancer Symposium, December 9-13, 2014; San Antonio, TX.

      6. Gauthier JM, T Nguyen, Johnson C, et al. Validation of a novel trastuzumab-induced cardiotoxicity prediction scale for breast cancer patients. Global Cardio-Oncology Summit, October 15-16, 2015, Nashville TN.

        • Romond E.H.
        • Jeong J.H.
        • Rastogi P.
        • et al.
        Seven year follow-up assessment of cardiac function in nsabp-31, a randomized trial comparing doxorubicin and cyclophosphamide followed by paclitaxel (acp) with acp plus trastuzumab as adjuvant therapy for patients with node-positive, human epidermal growth factor 2- positive breast cancer.
        J Clin Oncol. 2012; 30: 3792-3799
        • Ezaz G.
        • Long J.B.
        • Gross C.P.
        • Chen J.
        Risk prediction model for heart failure and cardiomyopathy after adjuvant trastuzumab therapy for breast cancer.
        J Am Heart Assoc. 2014; 3: e000472